Publications by authors named "Joachim Heinrich"

570 Publications

[Molar incisor hypomineralisation (MIH)-discussion of prevalence and etiology with special reference to the results from the Munich birth cohorts GINIplus and LISA].

Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021 Jul 2. Epub 2021 Jul 2.

Institut für Epidemiologie, Helmholtz Zentrum München - Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Deutschland.

After caries, molar incisor hypomineralisation (MIH)-also known as chalky teeth-is one the most common dental diseases in children and adolescents. In addition to aesthetic limitations, especially on the anterior teeth, hypersensitivities and enamel breakdowns on permanent molars are of functional importance. While the MIH prevalence rates range from ~ 10% to ~ 30% and is well described, the situation regarding aetiology is unsatisfactory. Although efforts have been made in the past to clarify the aetiology, no plausible reason is available so far. Aetiology research has to be judged as methodologically challenging, since it should ideally be embedded in prospectively planned birth cohort studies. The aim of this article is to summarize typical clinical characteristics of MIH, epidemiological findings and potential causes with special reference to the earlier published results from the two Munich birth cohort studies GINIplus and LISA.
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http://dx.doi.org/10.1007/s00103-021-03366-1DOI Listing
July 2021

The Burden of COPD Due to Ozone Exposure in Germany.

Dtsch Arztebl Int 2021 Jul 26(Forthcoming). Epub 2021 Jul 26.

Background: The chronic effects of ozone have only rarely been investigated in disease burden studies to date. Our goal was to determine this disease burden in Germany over the period 2007-2016, with particular attention to estimation based on effect estimates adjusted for particulate matter (PM) and nitrogen dioxide (NO).

Methods: The nationwide, high-spatial-resolution (2 km × 2 km), population-based exposure to ozone in the summer months ("summer ozone") was calculated on the basis of modeled ozone data and population counts in Germany. Next, risk estimates derived from cohort studies were used to quantify the burden of chronic obstructive pulmonary disease (COPD). Data on population counts, life expectancy, and mortality in Germany were used to reflect the situation across the country as accurately as possible.

Results: The estimates of years of life lost (YLL) due to summer ozone ranged from 18.33 per 100 000 people (95% confidence interval [14.02; 22.08]) in 2007 to 35.77 per 100 000 people [27.45; 42.98] in 2015. These findings indicate that ozone affects the COPD burden independently of other harmful components of the air. No clear secular trend in the COPD burden can be seen over the period 2007 to 2016.

Conclusion: Long-term exposure to ozone contributes to the COPD burden among the general population in Germany. As climate change may lead to a rise in the ozone concentration, more intensive research is required on the effects of ozone on health.
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http://dx.doi.org/10.3238/arztebl.m2021.0258DOI Listing
July 2021

Bronchodilator response and lung function decline: Associations with exhaled nitric oxide with regard to sex and smoking status.

World Allergy Organ J 2021 May 18;14(5):100544. Epub 2021 May 18.

Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden.

Background: Fractional exhaled nitric oxide (FeNO) is a marker of type-2 inflammation used both to support diagnosis of asthma and follow up asthma patients. The associations of FeNO with lung function decline and bronchodilator (BD) response have been studied only scarcely in large populations.

Objectives: To study the association between FeNO and a) retrospective lung function decline over 20 years, and b) lung function response to BD among asthmatic subjects compared with non-asthmatic subjects and with regards to current smoking and sex.

Methods: Longitudinal analyses of previous lung function decline and FeNO level at follow-up and cross-sectional analyses of BD response and FeNO levels in 4257 participants (651 asthmatics) from the European Community Respiratory Health Survey.

Results: Among asthmatic subjects, higher percentage declines of FEV and FEV/FVC were associated with higher FeNO levels (p = 0.001 for both) at follow-up. These correlations were found mainly among non-smoking individuals (p = 0.001) and females (p = 0.001) in stratified analyses.Percentage increase in FEV after BD was positively associated with FeNO levels in non-asthmatic subjects. Further, after stratified for sex and smoking separately, a positive association was seen between FEV and FeNO levels in non-smokers and women, regardless of asthma status.

Conclusions: We found a relationship between elevated FeNO and larger FEV decline over 20 years among subjects with asthma who were non-smokers or women. The association between elevated FeNO levels and larger BD response was found in both non-asthmatic and asthmatic subjects, mainly in women and non-smoking subjects.
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http://dx.doi.org/10.1016/j.waojou.2021.100544DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8142084PMC
May 2021

Street view greenness is associated with lower risk of obesity in adults: Findings from the 33 Chinese community health study.

Environ Res 2021 Jun 2;200:111434. Epub 2021 Jun 2.

Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China. Electronic address:

Background: Urban greenness may protect against obesity, but very few studies have assessed 'street view' (SV) greenness metrics, which may better capture people's actual exposure to greenness compared to commonly-used satellite-derived metrics. We aimed to investigate these associations further in a Chinese adult study.

Methods: Our analysis included 24,845 adults in the 33 Chinese Community Health Study in 2009. SV images from Tencent Map, segmented by machine learning algorithms, were used to determine the average proportion of green vegetation in SV images at community level in 800m road network buffer. Sensitivity analyses were performed with an alternative buffer size. Overall greenness was assessed as normalized difference vegetation index (NDVI) in 800 m buffer. We used predicted PM and monitored NO as proxies of air pollution. Body mass index (BMI), waist circumference (WC) and hip circumference (HC) were regressed on SV greenness by generalized linear mixed models, with adjustment for covariates. Mediation analyses were performed to assess the mediation effects of air pollution.

Results: Each interquartile range (IQR = 3.6%) increase in street view greenness was associated with a 0.15 kg/m (95% CI: -0.22, -0.09) decrease in BMI and 0.23 cm (95% CI: -0.35, -0.11) reduction in HC, and was associated with 7% lower odds of overweight (OR = 0.93, 95% CI:0.90, 0.96) and 18% lower odds of obesity (OR = 0.82, 95% CI:0.76, 0.89). Similar effect estimation was observed compared with commonly-used NDVI measures. PM and NO mediated 15.5% and 6.1% of the effects of SV greenness with BMI, respectively.

Conclusions: Our findings suggest beneficial associations between community-level SV greenness and lower body weight in Chinese adults. The effects were observed in women but not in men. Air pollution may partially mediate the association. These findings may have implications to support efforts to promote greening in urban areas.
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http://dx.doi.org/10.1016/j.envres.2021.111434DOI Listing
June 2021

Distribution and Polarization of Caries in Adolescent Populations.

Int J Environ Res Public Health 2021 05 3;18(9). Epub 2021 May 3.

Department of Conservative Dentistry and Periodontology, School of Dentistry, Ludwig-Maximilians-Universität München, 80336 Munich, Germany.

The aim of this study was to determine the proportion of adolescents with severe caries to analyze the prevalence of caries and to visualize the unequal distribution. Data from three epidemiological studies (10- and 15-year-olds: GINIplus and LISA cohorts in Munich, Bavaria; 12-year-olds: LAGZ survey in Bavaria, Germany) with 2875 adolescents were available for analysis. All individuals were examined according to the WHO standard. Statistics included the calculation of mean dmft/DMFT values (standard deviation), Significant Caries Index (SiC) values, Specific Affected Caries Index (SaC) values, and Lorenz curves. Overall caries-free status was 58.6% in primary and 83.9% in secondary teeth (10-year-olds), 61.5% (12-year-olds), and 64.6% (15-year-olds). The proportion of 12- and 15-year-olds with at least four DMFTs was 9.4% and 8.3%, respectively. In addition, eight 15-year-olds with DMFT values ≥8 (0.6%) were registered. The SaC/SiC values amounted to 1.8/0.9 DMFT (10-year-olds), 2.6/2.8 DMFT (12-year-olds), and 2.5/2.5 DMFT (15-year-olds). The mean DMFT values in the upper 1% of subjects were 4.2 DMFT (10-year-olds), 8.5 DMFT (12-year-olds), and 8.5 DMFT (15-year-olds). Thus, caries is not equally distributed throughout adolescence, but individuals with severe caries are rare. Nevertheless, further interdisciplinary research seems to be needed to clarify potential risk factors.
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http://dx.doi.org/10.3390/ijerph18094878DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8125661PMC
May 2021

The coexistence of asthma and COPD: risk factors, clinical history and lung function trajectories.

Eur Respir J 2021 Apr 16. Epub 2021 Apr 16.

Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.

Rationale: Patients with concomitant features of asthma and chronic obstructive pulmonary disease (COPD) have a heavy disease burden.

Objectives: Using data collected prospectively in the European Community Respiratory Health Survey, we compared the risk factors, clinical history, and lung function trajectories from early adulthood to the late sixties of middle aged subjects having asthma+COPD (n=179), past (n=263) or current (n=808) asthma alone, COPD alone (n=111), or none of these (n=3477).

Methods: Interview data and prebronchodilator FEV and FVC were obtained during three clinical examinations in 1991-1993, 1999-2002, and 2010-2013. Disease status was classified in 2010-2013, when the subjects were aged 40-68, according to the presence of fixed airflow obstruction (postbronchodilator FEV/FVC below the lower limit of normal), a lifetime history of asthma, and cumulative exposure to tobacco or occupational inhalants. Previous lung function trajectories, clinical characteristics, and risk factors of these phenotypes were estimated.

Main Results: Subjects with asthma+COPD reported maternal smoking (28.2%) and respiratory infections in childhood (19.1%) more frequently than subjects with COPD alone (20.9 and 14.0%, respectively). Subjects with asthma+COPD had an impairment of lung function at age 20 that tracked over adulthood, and more than half of them had asthma onset in childhood. Subjects with COPD alone had the highest lifelong exposure to tobacco smoking and occupational inhalants, and they showed accelerated lung function decline during adult life.

Conclusions: The coexistence between asthma and COPD seems to have its origins earlier in life compared to COPD alone. These findings suggest that prevention of this severe condition, which is typical at older ages, should start in childhood.
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http://dx.doi.org/10.1183/13993003.04656-2020DOI Listing
April 2021

Maternal exposure to ambient air pollution and congenital heart defects in China.

Environ Int 2021 08 7;153:106548. Epub 2021 Apr 7.

Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China. Electronic address:

Background: Evidence of maternal exposure to ambient air pollution on congenital heart defects (CHD) has been mixed and are still relatively limited in developing countries. We aimed to investigate the association between maternal exposure to air pollution and CHD in China.

Method: This longitudinal, population-based, case-control study consecutively recruited fetuses with CHD and healthy volunteers from 21 cities, Southern China, between January 2006 and December 2016. Residential address at delivery was linked to random forests models to estimate maternal exposure to particulate matter with an aerodynamic diameter of ≤ 1 µm (PM), ≤2.5 µm, and ≤10 µm as well as nitrogen dioxides, in three trimesters. The CHD cases were evaluated by obstetrician, pediatrician, or cardiologist, and confirmed by cardia ultrasound. The CHD subtypes were coded using the International Classification Diseases. Adjusted logistic regression models were used to assess the associations between air pollutants and CHD and its subtypes.

Results: A total of 7055 isolated CHD and 6423 controls were included in the current analysis. Maternal air pollution exposures were consistently higher among cases than those among controls. Logistic regression analyses showed that maternal exposure to all air pollutants during the first trimester was associated with an increased odds of CHD (e.g., an interquartile range [13.3 µg/m] increase in PM was associated with 1.09-fold ([95% confidence interval, 1.01-1.18]) greater odds of CHD). No significant associations were observed for maternal air pollution exposures during the second trimester and the third trimester. The pattern of the associations between air pollutants and different CHD subtypes was mixed.

Conclusions: Maternal exposure to greater levels of air pollutants during the pregnancy, especially the first trimester, is associated with higher odds of CHD in offspring. Further longitudinal well-designed studies are warranted to confirm our findings.
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http://dx.doi.org/10.1016/j.envint.2021.106548DOI Listing
August 2021

Associations of Particulate Matter Sizes and Chemical Constituents with Blood Lipids: A Panel Study in Guangzhou, China.

Environ Sci Technol 2021 04 25;55(8):5065-5075. Epub 2021 Mar 25.

State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Environmental Protection, Guangzhou 510655, China.

Existing evidence is scarce concerning the various effects of different PM sizes and chemical constituents on blood lipids. A panel study that involved 88 healthy college students with five repeated measurements (440 blood samples in total) was performed. We measured mass concentrations of particulate matter with diameters ≤ 2.5 μm (PM), ≤1.0 μm (PM), and ≤0.5 μm (PM) as well as number concentrations of particulate matter with diameters ≤ 0.2 μm (PN) and ≤0.1 μm (PN). We applied linear mixed-effect models to assess the associations between short-term exposure to different PM size fractions and PM constituents and seven lipid metrics. We found significant associations of greater concentrations of PM in different size fractions within 5 days before blood collection with lower high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A (ApoA1) levels, higher apolipoprotein B (ApoB) levels, and lower ApoA1/ApoB ratios. Among the PM constituents, we observed that higher concentrations of tin and lead were significantly associated with decreased HDL-C levels, and higher concentrations of nickel were associated with higher HDL-C levels. Our results suggest that short-term exposure to PM in different sizes was deleteriously associated with blood lipids. Some constituents, especially metals, might be the major contributors to the detrimental effects.
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http://dx.doi.org/10.1021/acs.est.0c06974DOI Listing
April 2021

Outdoor air pollution and hormone-assessed pubertal development in children: Results from the GINIplus and LISA birth cohorts.

Environ Int 2021 07 10;152:106476. Epub 2021 Mar 10.

Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital Munich, Comprehensive Pneumology Center (CPC) Munich, member, German Center for Lung Research (DZL), Munich, Germany; Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia. Electronic address:

Background: Air pollution is hypothesized to affect pubertal development. However, the few studies on this topic yielded overall mixed results. These studies did not consider important pollutants like ozone, and none of them involved pubertal development assessed by estradiol and testosterone measurements. We aimed to analyze associations between long-term exposure to four pollutants and pubertal development based on sex hormone concentrations among 10-year-old children.

Methods: These cross-sectional analyses were based on the 10-year follow-up medical examinations of 1945 children from the Munich and Wesel centers of the GINIplus and LISA German birth cohorts. Female and male pubertal development was assessed by dichotomizing the concentration of hormones in serum at 18.4 pmol/L and 0.087 nmol/L using the lower limits of quantification for estradiol and testosterone, respectively. Land-use regression models derived annual average concentrations of particulate matter with an aerodynamic diameter < 2.5 and 10 µm (PM and PM), as well as spatial models assessed yearly average concentrations of nitrogen dioxide (NO) and ozone, were calculated at the 10-year residential addresses. To evaluate associations, we utilized logistic regressions adjusted for potential covariates. The analyses were stratified by area and sex.

Results: Around 73% of the 943 females and 25% of the 1002 males had a high level of hormones and had already started puberty at the age of 10. Overall, we found no statistically significant associations between exposure to particles (PM or PM) and pubertal development. Results on NO and ozone were not significant as well; for instance, per 10 µg/m increase in ozone concentration, odds ratios and 95% confidence intervals were 0.900 (0.605, 1.339) and 0.830 (0.573, 1.203) for females and males, respectively. Stratified by area, the aforementioned results did not reveal any associations either.

Conclusions: Our study did not observe the associations between ambient air pollutants and pubertal development determined by estradiol and testosterone levels in children. However, due to the current limited number of studies on this topic, our results should be cautiously interpreted. Future longitudinal studies are needed to assess the association.
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http://dx.doi.org/10.1016/j.envint.2021.106476DOI Listing
July 2021

Associations between dog keeping and indoor dust microbiota.

Sci Rep 2021 Mar 5;11(1):5341. Epub 2021 Mar 5.

Department of Health Security, Finnish Institute for Health and Welfare, Neulaniementie 4, P.O. Box 95, 70701, Kuopio, Finland.

Living with dogs appears to protect against allergic diseases and airway infections, an effect possibly linked with immunomodulation by microbial exposures associated with dogs. The aim of this study was to characterize the influence of dog ownership on house dust microbiota composition. The bacterial and fungal microbiota was characterized with Illumina MiSeq sequencing from floor dust samples collected from homes in a Finnish rural-suburban (LUKAS2, N = 182) birth cohort, and the results were replicated in a German urban (LISA, N = 284) birth cohort. Human associated bacteria variable was created by summing up the relative abundances of five bacterial taxa. Bacterial richness, Shannon index and the relative abundances of seven bacterial genera, mostly within the phyla Proteobacteria and Firmicutes, were significantly higher in the dog than in the non-dog homes, whereas the relative abundance of human associated bacteria was lower. The results were largely replicated in LISA. Fungal microbiota richness and abundance of Leucosporidiella genus were higher in dog homes in LUKAS2 and the latter association replicated in LISA. Our study confirms that dog ownership is reproducibly associated with increased bacterial richness and diversity in house dust and identifies specific dog ownership-associated genera. Dogs appeared to have more limited influence on the fungal than bacterial indoor microbiota.
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http://dx.doi.org/10.1038/s41598-021-84790-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7935950PMC
March 2021

Greenness may improve lung health in low-moderate but not high air pollution areas: Seven Northeastern Cities' study.

Thorax 2021 Feb 25. Epub 2021 Feb 25.

Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China

Introduction: There is growing interest in the impact of greenness exposure on airway diseases, but the impact of greenness on lung function in children is limited. We aimed to investigate the associations between greenness surrounding schools and lung function in children and whether these associations are modified by air pollution exposure.

Methods: Between 2012 and 2013, a cross-sectional survey and spirometry were performed among 6740 school children. Lung function patterns were determined as obstructive forced expiratory volume 1 s/forced vital capacity (FEV/FVC <0.8) or restrictive (FEV/FVC ≥0.8 but FVC <80% of predicted). School greenness was defined by Normalized difference vegetation index (NDVI) and soil-adjusted vegetation index. Nitrogen dioxide, sulphur dioxide and particular matter concentrations were assessed using a spatiotemporal model and national monitoring data. Two-level generalised linear models were used to investigate associations and interactions.

Results: Overall, an IQR in NDVI within 500 m was associated with higher FEV (+57 mL 95% CI 44 to 70) and FVC (+58 mL 95% CI 43 to 73). NDVI was similarly associated with 25% reduced odds of spirometric restriction (OR: 0.75, 95% CI 0.65 to 0.86). However, among children exposed to the highest compared with the lowest quartile of particulate matter, increasing NDVI was paradoxically associated with lower -40 mL FVC (95% CI -47 to -33, p <0.05).

Discussion: Our findings suggest that, in this study population, greening urban areas may promote lung health in low-moderate pollution areas but not in high air pollution areas. If the findings are replicated in other moderate-to-high pollution settings, this highlights a need to have a flexible green policy.
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http://dx.doi.org/10.1136/thoraxjnl-2020-214767DOI Listing
February 2021

The mediating role of lung function on air pollution-induced cardiopulmonary mortality in elderly women: The SALIA cohort study with 22-year mortality follow-up.

Int J Hyg Environ Health 2021 Apr 11;233:113705. Epub 2021 Feb 11.

IUF-Leibniz Institute for Environmental Medicine, Auf'm Hennekamp 50, 40225, Düsseldorf, Germany. Electronic address:

Background: Air pollution exposure is associated with reduced lung function and increased cardio-pulmonary mortality (CPM).

Objectives: We analyzed the potential mediating effect of reduced lung function on the association between air pollution exposure and CPM.

Methods: We used data from the German SALIA cohort including 2527 elderly women (aged 51-56 years at baseline 1985-1994) with 22-year follow-up to CPM. Exposures to PM, PM, PM absorbance, NO and NO were assessed by land-use regression modelling and back-extrapolated to estimate exposures at baseline. Lung function (FVC, FEV) was measured by spirometry and transformed to GLI z-scores. Adjusted Cox proportional hazards and causal proportional hazards mediation analysis models were fitted.

Results: The survival analysis showed that reduced lung function (z-scores of FVC or FEV below 5% predicted) reflected significantly lower survival probability from CPM (p < 0.0001). Longterm exposures to NO and NO were associated with increased risks of CPM (eg. HR = 1.215; 95%CI: 1.017-1.452 for IQR increase in NO and HR = 1.209; 95%CI: 1.011-1.445 for IQR increase in NO) after adjusting for reduced lung function and additional covariates. The associations of PM absorbance and CPM remained significant in models adjusted for FEV/FVC, but the associations with PM and PM were not significant. The mediation analysis showed significant indirect effects of NO and NO on CPM mediated through reduced FEV and FVC. The largest indirect effects were found for exposures to NO (HR = 1.037; 95%CI: 1.005-1.070) and NO (HR = 1.028; 95%CI: 1.004-1.052) mediated through reduced FVC. The mediated proportion effect ranged from 13.9% to 19.6% in fully adjusted models.

Discussion: This study provides insights into the mechanism of reduced lung function in association between long-term air pollution exposure and CPM. The mediated effect was substantial for exposure to nitrogen oxides (NO and NO), but less pronounced for PM and PM.
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http://dx.doi.org/10.1016/j.ijheh.2021.113705DOI Listing
April 2021

Microbial diversity in homes and the risk of allergic rhinitis and inhalant atopy in two European birth cohorts.

Environ Res 2021 05 11;196:110835. Epub 2021 Feb 11.

Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland. Electronic address:

Background: Microbial exposures in early childhood direct the development of the immune system and their diversity may influence the risk of allergy development. We aimed to determine whether the indoor microbial diversity at early-life is associated with the development of allergic rhinitis and inhalant atopy.

Methods: The study population included children within two birth cohorts: Finnish rural-suburban LUKAS (N = 312), and German urban LISA from Munich and Leipzig study centers (N = 248). The indoor microbiota diversity (Chao1 richness and Shannon entropy) was characterized from floor dust samples collected at the child age of 2-3 months by Illumina MiSeq sequencing of bacterial and fungal DNA amplicons. Allergic rhinitis and inhalant atopy were determined at the age of 10 years and analyzed using logistic regression models.

Results: High bacterial richness (aOR 0.19, 95%CI 0.09-0.42 for middle and aOR 0.12, 95%CI 0.05-0.29 for highest vs. lowest tertile) and Shannon entropy were associated with lower risk of allergic rhinitis in LISA, and similar trend was seen in LUKAS. We observed some significant associations between bacterial and fungal diversity measured and the risk of inhalant atopy, but the associations were inconsistent between the two cohorts. High bacterial diversity tended to be associated with increased risk of inhalant atopy in rural areas, but lower risk in more urban areas. Fungal diversity tended to be associated with increased risk of inhalant atopy only in LISA.

Conclusions: Our study suggests that a higher bacterial diversity may reduce the risk of allergic rhinitis later in childhood. The environment-dependent heterogeneity in the associations with inhalant atopy - visible here as inconsistent results between two differing cohorts - suggests that specific constituents of the diversity may be relevant.
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http://dx.doi.org/10.1016/j.envres.2021.110835DOI Listing
May 2021

Long-term Air Pollution Exposure Under European Union Limits and Adolescents' Lung Function: Modifying Effect of Abnormal Weight in the GINIplus and LISA Birth Cohorts.

Chest 2021 Jul 10;160(1):249-258. Epub 2021 Feb 10.

Department of Epidemiology, IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany. Electronic address:

Background: Abnormal weights, eg, obesity, has shown a strong modifying effect on the association between air pollution exposure and lung function impairment in adults.

Research Question: How might weight status modify the effects of long-term air pollution exposure on adolescents' lung function, particularly in areas with pollution levels much lower than the current European Union (EU) air quality standards?

Study Design And Methods: In this observational study, we investigated 2,224 adolescents from the German Infant Study on the Influence of Nutrition Intervention Plus Environmental and Genetic Influences on Allergy Development and the Influence of Life Style Factors on the Development of the Immune System and Allergies in East and West Germany birth cohorts. Lung function was measured at age 15 years. Underweight, normal weight, and overweight or obese were defined using percentiles of BMI. Average concentrations of air pollution were modelled at residential addresses at four exposure windows between 0 and 15 years. Multivariate linear regression models were fitted by weight group on lung function with exposure at each window or cumulative exposure since birth.

Results: The median air pollution concentrations were half to two-thirds of the EU standards. Significant associations were observed only for individuals who were underweight and overweight or obese. For example, per interquartile range increase in nitrogen dioxide at the 15-year exposure window, FEV declined by -2.9% (95% CI, -5.2% to -0.5%) for the underweight group and -3.4% (95% CI, -5.4% to -1.2%) for the overweight or obese group. Similarly, longer exposure to moderate-level air pollution since birth was associated significantly with lung function impairment for groups with abnormal weight.

Interpretation: Exposure to low to moderate levels of air pollution was associated with lung function impairment for adolescents with abnormal weight. Longer exposure aggravated the adverse effect. Whether a critical exposure window since birth exists warrants further exploration.
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http://dx.doi.org/10.1016/j.chest.2021.02.007DOI Listing
July 2021

Genome-wide association study of circulating interleukin 6 levels identifies novel loci.

Hum Mol Genet 2021 Apr;30(5):393-409

Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK.

Interleukin 6 (IL-6) is a multifunctional cytokine with both pro- and anti-inflammatory properties with a heritability estimate of up to 61%. The circulating levels of IL-6 in blood have been associated with an increased risk of complex disease pathogenesis. We conducted a two-staged, discovery and replication meta genome-wide association study (GWAS) of circulating serum IL-6 levels comprising up to 67 428 (ndiscovery = 52 654 and nreplication = 14 774) individuals of European ancestry. The inverse variance fixed effects based discovery meta-analysis, followed by replication led to the identification of two independent loci, IL1F10/IL1RN rs6734238 on chromosome (Chr) 2q14, (Pcombined = 1.8 × 10-11), HLA-DRB1/DRB5 rs660895 on Chr6p21 (Pcombined = 1.5 × 10-10) in the combined meta-analyses of all samples. We also replicated the IL6R rs4537545 locus on Chr1q21 (Pcombined = 1.2 × 10-122). Our study identifies novel loci for circulating IL-6 levels uncovering new immunological and inflammatory pathways that may influence IL-6 pathobiology.
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http://dx.doi.org/10.1093/hmg/ddab023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8098112PMC
April 2021

Long-term effects of hydrolyzed formulae on atopic diseases in the GINI study.

Allergy 2021 06 24;76(6):1903-1907. Epub 2020 Dec 24.

Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany.

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http://dx.doi.org/10.1111/all.14709DOI Listing
June 2021

Integration of gene expression and DNA methylation identifies epigenetically controlled modules related to PM exposure.

Environ Int 2021 01 16;146:106248. Epub 2020 Nov 16.

Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Sweden. Electronic address:

Air pollution has been associated with adverse health effects across the life-course. Although underlying mechanisms are unclear, several studies suggested pollutant-induced changes in transcriptomic profiles. In this meta-analysis of transcriptome-wide association studies of 656 children and adolescents from three European cohorts participating in the MeDALL Consortium, we found two differentially expressed transcript clusters (FDR p < 0.05) associated with exposure to particulate matter < 2.5 µm in diameter (PM) at birth, one of them mapping to the MIR1296 gene. Further, by integrating gene expression with DNA methylation using Functional Epigenetic Modules algorithms, we identified 9 and 6 modules in relation to PM exposure at birth and at current address, respectively (including NR1I2, MAPK6, TAF8 and SCARA3). In conclusion, PM exposure at birth was linked to differential gene expression in children and adolescents. Importantly, we identified several significant interactome hotspots of gene modules of relevance for complex diseases in relation to PM exposure.
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http://dx.doi.org/10.1016/j.envint.2020.106248DOI Listing
January 2021

Association of early life and acute pollen exposure with lung function and exhaled nitric oxide (FeNO). A prospective study up to adolescence in the GINIplus and LISA cohort.

Sci Total Environ 2021 Apr 20;763:143006. Epub 2020 Oct 20.

Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia; Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia. Electronic address:

Background: Pollen exposure has both acute and chronic detrimental effects on allergic asthma, but little is known about its wider effects on respiratory health. This is increasingly important knowledge as ambient pollen levels are changing with the changing global climate.

Objective: To assess associations of pollen exposure with lung function and fractional exhaled nitric oxide (FeNO) at age 15 in two prospective German birth cohorts, GINIplus and LISA.

Methods: Background city-specific pollen exposure was measured in infancy (during the first three months of life), and contemporary (on the day of and 7 days prior to lung function measurement). Greenness levels within circular buffers (100-3000 m) around the birth and 15-year home addresses were calculated using the satellite-derived Normalized Difference Vegetation Index. Regression models were used to assess the associations of grass and birch pollen with lung function and FeNO, and the modifying effects of residential greenness were explored.

Results: Cumulative early life exposure to grass pollen was associated with reduced lung function in adolescence (FEV: -4.9 mL 95%CI: -9.2, -0.6 and FVC: -5.2 mL 95%CI: -9.8, -0.5 per doubling of pollen count). Acute grass pollen exposure was associated with increased airway inflammation in all children, with higher FeNO increases in children living in green areas. In contrast acute birch pollen exposure was associated with reduced lung function only in children sensitised to birch allergens.

Conclusion: This study provides suggestive evidence that early pollen exposure has a negative effect on later lung function, which is in turn influenced by acute pollen exposures.
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http://dx.doi.org/10.1016/j.scitotenv.2020.143006DOI Listing
April 2021

Lifelong exposure to air pollution and greenness in relation to asthma, rhinitis and lung function in adulthood.

Environ Int 2021 01 27;146:106219. Epub 2020 Oct 27.

Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.

Objectives: To investigate if air pollution and greenness exposure from birth till adulthood affects adult asthma, rhinitis and lung function.

Methods: We analysed data from 3428 participants (mean age 28) in the RHINESSA study in Norway and Sweden. Individual mean annual residential exposures to nitrogen dioxide (NO), particulate matter (PM and PM), black carbon (BC), ozone (O) and greenness (normalized difference vegetation index (NDVI)) were averaged across susceptibility windows (0-10 years, 10-18 years, lifetime, adulthood (year before study participation)) and analysed in relation to physician diagnosed asthma (ever/allergic/non-allergic), asthma attack last 12 months, current rhinitis and low lung function (lower limit of normal (LLN), z-scores of forced expiratory volume in one second (FEV), forced vital capacity (FVC) and FEV/FVC below 1.64). We performed logistic regression for asthma attack, rhinitis and LLN lung function (clustered with family and study centre), and conditional logistic regression with a matched case-control design for ever/allergic/non-allergic asthma. Multivariable models were adjusted for parental asthma and education.

Results: Childhood, adolescence and adult exposure to NO, PM and O were associated with an increased risk of asthma attacks (ORs between 1.29 and 2.25), but not with physician diagnosed asthma. For rhinitis, adulthood exposures seemed to be most important. Childhood and adolescence exposures to PM and O were associated with lower lung function, in particular FEV (range ORs 2.65 to 4.21). No associations between NDVI and asthma or rhinitis were revealed, but increased NDVI was associated with lower FEV and FVC in all susceptibility windows (range ORs 1.39 to 1.74).

Conclusions: Air pollution exposures in childhood, adolescence and adulthood were associated with increased risk of asthma attacks, rhinitis and low lung function in adulthood. Greenness was not associated with asthma or rhinitis, but was a risk factor for low lung function.
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http://dx.doi.org/10.1016/j.envint.2020.106219DOI Listing
January 2021

Air pollution during infancy and lung function development into adolescence: The GINIplus/LISA birth cohorts study.

Environ Int 2021 01 21;146:106195. Epub 2020 Oct 21.

Department of Epidemiology, IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany. Electronic address:

Background: Limited evidence exists on how air pollution exposure during infancy, i.e. the first year of life, may affect lung function development into adolescence.

Objectives: To investigate the association between exposure to air pollution during the first-year of life and lung function development up to the age of 15 in Germany.

Methods: We investigated 915 children from the GINIplus and LISA birth cohorts from Munich (n = 181) and Wesel (n = 734), who had at least two spirometric measurements at ages 6, 10 and 15. Z-scores of forced expiratory volume in one second (FEV) and forced vital capacity (FVC) were calculated. Annual average concentrations of nitrogen dioxide, particulate matter with diameters <2.5, <10 and 2.5-10 µm (PM), and PM absorbance at home addresses during the first-year of life, were estimated by land-use regression models. Associations between infancy exposure and lung function changes were fitted using multivariable linear mixed models with adjustment for potential confounders.

Results: For per interquartile range increase in air pollutants during the first-year life, FEV z-scores declined annually by -0.012 (95% confidence interval (CI): -0.014, -0.009) for PM to -0.023 (95%CI: -0.028, -0.018) for PM. The declines in FVC were lower than FEV [-0.006 (95%CI: -0.008, -0.003) to -0.011 (95%CI: -0.019, -0.003)]. In Munich, the attenuations were only significant for FEV. Effect estimates of infancy exposure for certain air pollutants were higher for groups with asthma, older maternal age, and breastfeeding <12 weeks than their counterparts.

Discussion: Infancy exposure to higher air pollution may reduce lung function development up to adolescence, with airway size more affected than lung volume restriction. The potential modifying effects of maternal age, asthmatic status of children and breastfeeding warrant further exploration.
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http://dx.doi.org/10.1016/j.envint.2020.106195DOI Listing
January 2021

Cumulative Occupational Exposures and Lung-Function Decline in Two Large General-Population Cohorts.

Ann Am Thorac Soc 2021 02;18(2):238-246

Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Few longitudinal studies have assessed the relationship between occupational exposures and lung-function decline in the general population with a sufficiently long follow-up. To examine the potential association in two large cohorts: the ECRHS (European Community Respiratory Health Survey) and the SAPALDIA (Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults). General-population samples of individuals aged 18 to 62 were randomly selected in 1991-1993 and followed up approximately 10 and 20 years later. Spirometry (without bronchodilation) was performed at each visit. Coded complete job histories during follow-up visits were linked to a job-exposure matrix, generating cumulative exposure estimates for 12 occupational exposures. Forced expiratory volume in 1 second (FEV) and forced vital capacity (FVC) were jointly modeled in linear mixed-effects models, fitted in a Bayesian framework, taking into account age and smoking. A total of 40,024 lung-function measurements from 17,833 study participants were analyzed. We found accelerated declines in FEV and the FEV/FVC ratio for exposure to biological dust, mineral dust, and metals (FEV = -15.1 ml, -14.4 ml, and -18.7 ml, respectively; and FEV/FVC ratio = -0.52%, -0.43%, and -0.36%, respectively; per 25 intensity-years of exposure). These declines were comparable in magnitude with those associated with long-term smoking. No effect modification by sex or smoking status was identified. Findings were similar between the ECRHS and the SAPALDIA cohorts. Our results greatly strengthen the evidence base implicating occupation, independent of smoking, as a risk factor for lung-function decline. This highlights the need to prevent or control these exposures in the workplace.
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http://dx.doi.org/10.1513/AnnalsATS.202002-113OCDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8020720PMC
February 2021

Novel loci for childhood body mass index and shared heritability with adult cardiometabolic traits.

PLoS Genet 2020 10 12;16(10):e1008718. Epub 2020 Oct 12.

Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.

The genetic background of childhood body mass index (BMI), and the extent to which the well-known associations of childhood BMI with adult diseases are explained by shared genetic factors, are largely unknown. We performed a genome-wide association study meta-analysis of BMI in 61,111 children aged between 2 and 10 years. Twenty-five independent loci reached genome-wide significance in the combined discovery and replication analyses. Two of these, located near NEDD4L and SLC45A3, have not previously been reported in relation to either childhood or adult BMI. Positive genetic correlations of childhood BMI with birth weight and adult BMI, waist-to-hip ratio, diastolic blood pressure and type 2 diabetes were detected (Rg ranging from 0.11 to 0.76, P-values <0.002). A negative genetic correlation of childhood BMI with age at menarche was observed. Our results suggest that the biological processes underlying childhood BMI largely, but not completely, overlap with those underlying adult BMI. The well-known observational associations of BMI in childhood with cardio-metabolic diseases in adulthood may reflect partial genetic overlap, but in light of previous evidence, it is also likely that they are explained through phenotypic continuity of BMI from childhood into adulthood.
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http://dx.doi.org/10.1371/journal.pgen.1008718DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7581004PMC
October 2020

Association Between Residential Greenness, Cardiometabolic Disorders, and Cardiovascular Disease Among Adults in China.

JAMA Netw Open 2020 09 1;3(9):e2017507. Epub 2020 Sep 1.

Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, Sun Yat-sen University School of Public Health, Guangzhou, China.

Importance: Living in areas with more vegetation (referred to as residential greenness) may be associated with cardiovascular disease (CVD), but little data are available from low- and middle-income countries. In addition, it remains unclear whether the presence of cardiometabolic disorders modifies or mediates the association between residential greenness and CVD.

Objective: To evaluate the associations between residential greenness, cardiometabolic disorders, and CVD prevalence among adults in China.

Design, Setting, And Participants: This analysis was performed as part of the 33 Communities Chinese Health Study, a large population-based cross-sectional study that was conducted in 33 communities (ranging from 0.25-0.64 km2) in 3 cities within the Liaoning province of northeastern China between April 1 and December 31, 2009. Participants included adults aged 18 to 74 years who had resided in the study area for 5 years or more. Greenness levels surrounding each participant's residential community were assessed using the normalized difference vegetation index and the soil-adjusted vegetation index from 2010. Lifetime CVD status (including myocardial infarction, heart failure, coronary heart disease, cerebral thrombosis, cerebral hemorrhage, cerebral embolism, and subarachnoid hemorrhage) was defined as a self-report of a physician diagnosis of CVD at the time of the survey. Cardiometabolic disorders, including hypertension, diabetes, dyslipidemia, and overweight or obese status, were measured and defined clinically. Generalized linear mixed models were used to evaluate the association between residential greenness levels and CVD prevalence. A 3-way decomposition method was used to explore whether the presence of cardiometabolic disorders mediated or modified the association between residential greenness and CVD. Data were analyzed from October 10 to May 30, 2020.

Main Outcomes And Measures: Lifetime CVD status, the presence of cardiometabolic disorders, and residential greenness level.

Results: Among 24 845 participants, the mean (SD) age was 45.6 (13.3) years, and 12 661 participants (51.0%) were men. A total of 1006 participants (4.1%) reported having a diagnosis of CVD. An interquartile range (1-IQR) increase in the normalized difference vegetation index within 500 m of a community was associated with a 27% lower likelihood (odds ratio [OR], 0.73; 95% CI, 0.65-0.83; P < .001) of CVD prevalence, and an IQR increase in the soil-adjusted vegetation index within 500 m of a community was associated with a 26% lower likelihood (OR, 0.74; 95% CI, 0.66-0.84; P < .001) of CVD prevalence. The presence of cardiometabolic disorders was found to mediate the association between residential greenness and CVD, with mediation effects of 4.5% for hypertension, 4.1% for type 2 diabetes, 3.1% for overweight or obese status, 12.7% for hypercholesterolemia, 8.7% for hypertriglyceridemia, and 11.1% for high low-density lipoprotein cholesterol levels.

Conclusions And Relevance: In this cross-sectional study, higher residential greenness levels were associated with lower CVD prevalence, and this association may be partially mediated by the presence of cardiometabolic disorders. Further studies, preferably longitudinal, are warranted to confirm these findings.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.17507DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7506516PMC
September 2020

Air pollution and IgE sensitization in 4 European birth cohorts-the MeDALL project.

J Allergy Clin Immunol 2021 Feb 11;147(2):713-722. Epub 2020 Sep 11.

Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden. Electronic address:

Background: Whether long-term exposure air to pollution has effects on allergic sensitization is controversial.

Objective: Our aim was to investigate associations of air pollution exposure at birth and at the time of later biosampling with IgE sensitization against common food and inhalant allergens, or specific allergen molecules, in children aged up to 16 years.

Methods: A total of 6163 children from 4 European birth cohorts participating in the Mechanisms of the Development of ALLergy [MeDALL] consortium were included in this meta-analysis of the following studies: Children, Allergy, Milieu, Stockholm, Epidemiology (BAMSE) (Sweden), Influences of Lifestyle-Related Factors on the Human Immune System and Development of Allergies in Childhood (LISA)/German Infant Study on the Influence of Nutrition Intervention PLUS Environmental and Genetic Influences on Allergy Development (GINIplus) (Germany), and Prevention and Incidence of Asthma and Mite Allergy (PIAMA) (The Netherlands). The following indicators were modeled by land use regression: individual residential outdoor levels of particulate matter with aerodynamic diameters less than 2.5 μm, less than 10 μm, and between 2.5 and 10 μm; PM absorbance (a measurement of the blackness of PM filters); and nitrogen oxides levels. Blood samples drawn at ages 4 to 6 (n = 5989), 8 to 10 (n = 6603), and 15 to 16 (n = 5825) years were analyzed for IgE sensitization to allergen extracts by ImmunoCAP. Additionally, IgE against 132 allergen molecules was measured by using the MedALL microarray chip (n = 1021).

Results: Air pollution was not consistently associated with IgE sensitization to any common allergen extract up to age 16 years. However, allergen-specific analyses suggested increased risks of sensitization to birch (odds ratio [OR] = 1.12 [95% CI = 1.01-1.25] per 10-μg/m increase in NO exposure). In a subpopulation with microarray data, IgE to the major timothy grass allergen Phleum pratense 1 (Phl p 1) and the cat allergen Felis domesticus 1 (Fel d 1) greater than 3.5 Immuno Solid-phase Allergen Chip standardized units for detection of IgE antibodies were related to PM exposure at birth (OR = 3.33 [95% CI = 1.40-7.94] and OR = 4.98 [95% CI = 1.59-15.60], respectively, per 5-μg/m increase in exposure).

Conclusion: Air pollution exposure does not seem to increase the overall risk of allergic sensitization; however, sensitization to birch as well as grass pollen Phl p 1 and cat Fel d 1 allergen molecules may be related to specific pollutants.
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http://dx.doi.org/10.1016/j.jaci.2020.08.030DOI Listing
February 2021

Is PM similar to PM? A new insight into the association of PM and PM with children's lung function.

Environ Int 2020 12 8;145:106092. Epub 2020 Sep 8.

Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China. Electronic address:

Experimental data suggests that PM is more toxic than PM although the epidemiologic evidence suggests that the health associations are similar. However, few objective exposure data are available to compare the associations of PM and PM with children lung function. Our objectives are a) to evaluate associations between long-term exposure to PM, PM and children's lung function, and b) to compare the associations between PM and PM. From 2012 to 2013, we enrolled 6,740 children (7-14 years), randomly recruited from primary and middle schools located in seven cities in northeast China. We measured lung function including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), peak expiratory flow (PEF), and maximal mid-expiratory flow (MMEF) utilizing two portable electronic spirometers. We dichotomized continuous lung function measures according the expected values for gender and age. The spatial resolution at which PM and PM estimated were estimated using a machine learning method and the temporal average concentrations were averaged from 2009 to 2012. A multilevel regression model was used to estimate the associations of PM, PM exposure and lung function measures, adjusted for confounding factors. Associations with lower lung function were consistently larger for PM than for PM. Adjusted odds ratios (OR) per interquartile range greater PM ranged from 1.53 for MMEF (95% confidence interval [CI]: 1.20-1.96) to 2.14 for FEV1 (95% CI: 1.66-2.76) and ORs for PM ranged from 1.36 for MMEF (95%CI: 1.12-1.66) to 1.82 for FEV1 (95%CI: 1.49-2.22), respectively. PM and PM had significant associations with FVC and FEV1 in primary school children, and on PEF and MMEF in middle school children. Long-term PM and PM exposure can lead to decreased lung function in children, and the associations of PM are stronger than PM. Therefore, PM may be more hazardous to children's respiratory health than PM exposure.
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http://dx.doi.org/10.1016/j.envint.2020.106092DOI Listing
December 2020

Residing near allergenic trees can increase risk of allergies later in life: LISA Leipzig study.

Environ Res 2020 12 24;191:110132. Epub 2020 Aug 24.

Allergens in Ecosystems, Institute of Biochemical Plant Pathology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.

Background: We investigated whether residing in places with higher greenness, more trees and more allergenic trees early in life increases the risk of allergic outcomes, and whether these associations differ depending on the concentration of air pollutants.

Methods: The analytic sample included 631 children from the German birth cohort LISA Leipzig. Asthma and allergic rhinitis, sensitization to aeroallergens and food allergens, as well as confounders, were collected prospectively up to 15 years. Greenness was assessed by Normalized Difference Vegetation Index (NDVI). A tree registry was used to derive information on trees, which were classified into allergenic and non-allergenic. Annual average concentrations of nitrogen dioxide (NO) and ozone were also used. Geographic exposures were assigned to home addresses at birth. Longitudinal associations were analysed using generalized estimating equations.

Results: Medium and high numbers (tertiles) of trees and allergenic trees in a 500 m buffer around birth addresses were associated with increased odds of allergic rhinitis up to 15 years regardless of NDVI. These exposures were also related to higher odds of sensitization to aeroallergens. Associations with asthma and sensitization to food allergens were less consistent. Effect estimates for allergic rhinitis were stronger in the high tertile of NO compared to the low tertile, while an opposite tendency was observed for ozone.

Conclusion: We observed that early life residence in places with many trees, and allergenic trees specifically, may increase the prevalence of allergic rhinitis later in life. This association and its modification by air pollution should be pursued in further studies.
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http://dx.doi.org/10.1016/j.envres.2020.110132DOI Listing
December 2020

Physical activity and lung function-Cause or consequence?

PLoS One 2020 20;15(8):e0237769. Epub 2020 Aug 20.

ISGlobal, Barcelona, Spain.

Concerns exist that the positive association of physical activity with better lung function, which has been suggested in previous longitudinal studies in smokers, is due to reverse causation. To investigate this, we applied structural equation modeling (SEM), an exploratory approach, and marginal structural modeling (MSM), an approach from the causal inference framework that corrects for reverse causation and time-dependent confounding and estimates causal effects, on data from participants in the European Community Respiratory Health Survey (ECRHS, a multicentre European cohort study initiated in 1991-1993 with ECRHS I, and with two follow-ups: ECRHS II in 1999-2003, and ECRHS III in 2010-2014). 753 subjects who reported current smoking at ECRHS II, with repeated data on lung function at ECRHS I, II and III, physical activity at ECRHS II and III, and potential confounders at ECRHS I and II, were included in the analyses. SEM showed positive associations between physical activity and lung function in both directions. MSM suggested a protective causal effect of physical activity on lung function (overall difference in mean β (95% CI), comparing active versus non-active individuals: 58 mL (21-95) for forced expiratory volume in one second and 83 mL (36-130) for forced vital capacity). Our results suggest bi-directional causation and support a true protective effect of physical activity on lung function in smokers, after accounting for reverse causation and time-dependent confounding.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237769PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7446897PMC
October 2020

Associations of Preconception Exposure to Air Pollution and Greenness with Offspring Asthma and Hay Fever.

Int J Environ Res Public Health 2020 08 12;17(16). Epub 2020 Aug 12.

Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway.

We investigated if greenness and air pollution exposure in parents' childhood affect offspring asthma and hay fever, and if effects were mediated through parental asthma, pregnancy greenness/pollution exposure, and offspring exposure. We analysed 1106 parents with 1949 offspring (mean age 35 and 6) from the Respiratory Health in Northern Europe, Spain and Australia (RHINESSA) generation study. Mean particulate matter (PM and PM), nitrogen dioxide (NO), black carbon (BC), ozone (O) (µg/m) and greenness (normalized difference vegetation index (NDVI)) were calculated for parents 0-18 years old and offspring 0-10 years old, and were categorised in tertiles. We performed logistic regression and mediation analyses for two-pollutant models (clustered by family and centre, stratified by parental lines, and adjusted for grandparental asthma and education). Maternal medium PM and PM exposure was associated with higher offspring asthma risk (odds ratio (OR) 2.23, 95%CI 1.32-3.78, OR 2.27, 95%CI 1.36-3.80), and paternal high BC exposure with lower asthma risk (OR 0.31, 95%CI 0.11-0.87). Hay fever risk increased for offspring of fathers with medium O exposure (OR 4.15, 95%CI 1.28-13.50) and mothers with high PM exposure (OR 2.66, 95%CI 1.19-5.91). The effect of maternal PM exposure on offspring asthma was direct, while for hay fever, it was mediated through exposures in pregnancy and offspring's own exposures. Paternal O exposure had a direct effect on offspring hay fever. To conclude, parental exposure to air pollution appears to influence the risk of asthma and allergies in future offspring.
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http://dx.doi.org/10.3390/ijerph17165828DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7459891PMC
August 2020

Ozone exposure and health effects: a protocol for an umbrella review and effect-specific systematic maps.

BMJ Open 2020 08 13;10(8):e034854. Epub 2020 Aug 13.

Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany

Introduction: Ambient ozone exposure may be adverse to health. Since the reported associations between ozone and health effects are heterogeneous and the underlying pathways are indistinct, the overall relationship remains unclear. Only a few overall syntheses of the evidence regarding ozone and health effects are available to date.

Methods And Analysis: We plan to summarise the current evidence on ozone-related health effects systematically. First, to identify the possible associations between ambient ozone exposure and health outcomes, we will conduct an umbrella review. PubMed, Web of Science and grey literature will be searched for systematic reviews on exposure to ambient ozone and any possible health endpoints published before 31 May 2019. Data selection and extraction will be carried out by one reviewer, and a second reviewer will check the agreement of a sample of the studies. The methodological quality of the eligible systematic reviews and level of evidence regarding ozone and every specific health effect will be evaluated. Second, for each of the identified effects with a high level of evidence, comprehensive information retrievals will be conducted, considering both epidemiological and experimental studies. The study selection and data mapping will be carried out by one reviewer and checked by the second reviewer. We will summarise the information of the filtered epidemiological and experimental studies to conduct several systematic maps presenting the currently available evidence for the specific health effect. Because the association between ozone exposure and chronic obstructive pulmonary disease (COPD) is relatively well investigated, we will at least conduct one systematic map of ozone and COPD.

Ethics And Dissemination: No ethical approval is required for this study. The completed umbrella review and systematic maps will be considered for publication and presentation. We will additionally upload the relevant data to publicly accessible online databases.

Prospero Registration Number: CRD42019123064.
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http://dx.doi.org/10.1136/bmjopen-2019-034854DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7430459PMC
August 2020
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